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Individual
MR. JEREMIAH C. BRACK
Active
Individual
MR. JEREMIAH C. BRACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA12666
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PA12666
TEXAS MEDICAL BOARD
TX
Enumeration date
03/05/2015
Last updated
12/07/2021
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